Healthcare Provider Details

I. General information

NPI: 1194854513
Provider Name (Legal Business Name): MONICA LYNN SALAZAR LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SCENIC DR
MODESTO CA
95350-6131
US

IV. Provider business mailing address

800 SCENIC DR
MODESTO CA
95350-6131
US

V. Phone/Fax

Practice location:
  • Phone: 209-525-6100
  • Fax: 209-558-4326
Mailing address:
  • Phone: 209-525-6100
  • Fax: 209-558-4326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC40665
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: